MEDICARE: INDIAN VALLEY LOCAL SCHOOLS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251300000X	Local Education Agency (LEA)

General Provider Information

NPI Number	:	1366858441
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INDIAN VALLEY LOCAL SCHOOLS

Provider Business Mailing Address
First Line	:	PO BOX 171
Second Line	:	100 N. WALNUT ST.
City	:	GNADENHUTTEN
State	:	OH
Zip	:	44629
Country	:	US
Telephone Number	:	740-254-4334
Fax Number	:	740-254-9271

Provider Business Practice Location Address
First Line	:	100 N. WALNUT ST.
Second Line	:
City	:	GNADENHUTTEN
State	:	OH
Zip	:	44629
Country	:	US
Telephone Number	:	740-254-4334
Fax Number	:	740-254-9271

Authorized Official
Title or Position	:	SUPERINTENDENT
Name	:	MR. G. IRA WENTWORTH
Credential	:
Telephone Number	:	740-254-4334

Provider Enumeration Date	:	07/09/2014
Last Update Date	:	07/09/2014

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